DRUGS ACTING ON

CARDIOVASCULAR
SYSTEM
 ADH: antidiuretic hormone that ⬆ water retention
Aldosterone: hormones that ⬆ water and sodium
retention
Angiotensin: hormone that vasoconstricts and ⬆
aldosterone and ADH
Bradycardia: slow heart rate
Cardiac Output: volume of blood being pumped by heart
Hypertension: ⬆ BP
 Hypotension: ⬇ BP
Renin Angiotensin Aldosterone System: compensatory
process that ⬆blood pressure and blood volume
Tachycardia: fast heart rate
Vasoconstrict: constrict blood vessels
Vasodilate: dilate blood vessels
Upon completion of this concept, you will be able
to:
Label a diagram of the heart, including all
chambers, valves, great vessels, coronary vessels,
and the conduction system.
Define Hypertension and other cardiac problems
Identifythe different cardiovascular drugs and its
actions for normal controls of blood pressure.
Enumerate the different nursing responsibilities
when giving cardiac drugs
Discuss the side effects and complications of each
drug.
STRUCTURES AND FUNCTIONS

3 Major Components of Cardiovascular System:

 Heart

 Blood

 Blood Vessels
. The functions of the cardiovascular system are diverse and include
the following:
 Transport of nutrients and wastes
 Pumping of blood
 Regulation of blood pressure
 Regulation of acid–base balance
 Regulation of fluid balance
 Regulation of body temperature
 Protection against invasion by microbes
 Blood is a fluid tissue that consists of solid, formed elements
suspended in plasma. The solid, formed elements of the
blood are the erythrocytes, leukocytes, and platelets.
When combined, the formed elements comprise about
45% of the composition of blood.

BLOOD
 HEART
– a hollow muscle with four chambers
comprising two upper atria and two
lower ventricles, pumps oxygenated
blood to the body’s cells and also
collects waste products from the
tissues
BLOOD PRESSURE
 TWO-STEP PROCESS known as the
cardiac cycle includes:
DIASTOLE (resting period when the
veins carry blood back to the heart) and
SYSTOLE (contraction period when the
heart pumps blood out to the arteries
for distribution to the body)
 DEOXYGENATED BLOOD IS
CARRIED BY THE VEINS TO THE
RIGHT SIDE OF THE
HEART, WHICH DIRECTS THE
BLOOD TO THE LUNGS
WHERE IT TAKES ON OXYGEN
 OXYGENATED BLOOD FROM THE
LUNGS CIRCULATES TO THE
LEFT SIDE OF THE HEART TO
BEPUMPED OUT TO EVERY CELL
IN THE BODY THROUGH THE
ARTERIES
HYPERTENSION
HYPERTENSION – when a person’s
blood pressure is above normal limits
for a sustained period
HYPOTENSION – if a blood pressure
becomes too low, the vital centers in
the brain as well the rest of the tissues
of the body may not receive enough
oxygenated blood to continue
functioning
 TYPES of HYPERTENSION

1. Essential or Benign
2. Secondary
ANTI HYPERTENSIVE DRUGS
DEFINITION:

Antihypertensivemedications decrease blood

pressure and pulse by excreting sodium/water
and decreasing cardiac output.
Thesemedications treat hypertension,
tachycardia, and edema.
TYPES

Angiotensin-converting enzyme inhibitors (ACE inhibitors),

Angiotensin II receptor blockers (ARBs),

Beta-blockers,

Calcium channel blockers (CCBs),

Diuretics
The
Renin-Angiotensin-Aldosterone System
“RAAS System”
STEP ONE:
BLOOD
PRESSURE ⬇
 STEP TWO: Brain goes into “fight or
flight mode”

BRAIN CALLS THE KIDNEYS

STEP THREE: Kidneys
release Renin,
an enzyme to activate
Angiotensin I.
STEP FOUR: Angiotensin I activates
and gets ACE.
STEP FIVE: ACE converts
Angiotensin
I to Angiotensin II
STEP SIX: Angiotensin II vasoconstricts
and ⬆ ADH + Aldosterone = ⬆ BP
 RENIN AND SODIUM
RETENTION
- Cells in the kidneys respond to low
blood pressure by releasing an enzyme
called RENIN
 Through a complex series of events,
RENIN causes the kidneys to reabsorb
sodium

Sodium reabsorption, in turn, is always

accompanied by water retention, which
helps to restore blood volume and
blood pressure
- Renin also activates the blood protein
angiotensinogen to angiotensin
ANGIOTENSIN is a powerful
VASOCONSTRICTOR: it narrows the
diameters of blood vessels, thereby
raising the blood pressure
ANGIOTENSIN AND BLOOD
VESSEL CONSTRICTION
ANTIHYPERTENSIVE AGENTS

Stay on medications. Client has a

high tendency to stop a medication
when they are feeling better
ANGIOTENSIN-CONVERTING ENZYME
(ACE) INHIBITOR
 ACTION:

 Suppresses renin-angiotensin- aldosterone system: blocks conversion

of angiotensin I to angiotensin II (a potent vasoconstrictor)
 ACE inhibitors lower blood pressure by reducing peripheral vascular
resistance without reflexively increasing cardiac output, heart rate, or
contractility.
 Therapeutic
uses: hypertension, heart failure MI, diabetic
nephropathy, prevention of MI, stroke, and death for patients at
high-risk
 PHARMACOKINETICS

Metabolized and
excreted by the kidneys.
 ACE INHIBITORS

SIDE EFFECTS:

Dry Cough
RASH
FEVER
HYPOTENSION
ALTERED TASTE
 Administer all ACE inhibitors orally except enalapril at, which is given
IV
 Monitor BP
 Instruct
client to take captopril and moexipril at least I hr before
meals; others ACEIs can be taken without regard to food
 Instruct client to report cough, rash, or changes in taste
 Instruct client to change positions slowly
 Advise clients to avoid activities that require alertness until effect of
drug is known

NURSING INTERVENTION
ACE INHIBITORS
Benazepril (Lotension)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Perindopril (Aceon)
Quinapril (Accupril)
Ramipril (Altace)

“PRIL SISTERS”
CAPTOPRIL
CAPTOPRIL
 ACE INHIBITORS

CLIENT EDUCATION:
Report any signs of infection, bruising,
or bleeding
Captopril, Moexipril, Quinapril will
have reduced absorption if given with
food
ANGIOTENSINII RECEPTOR
BLOCKERS (ARBS)
These medications block angiotensin II receptors,
resulting in a decrease in blood pressure.
Their pharmacologic effects are similar to those of ACE
inhibitors in that they produce arteriolar and venous
dilation and block aldosterone secretion, thus lowering
blood pressure and decreasing salt and water retention
ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
Candesartan (Atacand)
Eprosartan (Teveten)
Irbesartan (Avapro)
Losartan (Cozaar)
Telmisartan (Micardis)
Valsartan (Diovan)

“SARTAN SISTERS”
ACTION:
Blocks the binding of angiotensin II to the
AT 1 receptor found in many tissues (ex.
adrenal, vascular smooth muscle)
This blocks the vasoconstriction effect of
the renin-angiotensin system as well as
the release of aldosterone resulting in
decrease BP
ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
INDICATION:
Hypertension. Used alone or with other
antihypertensives

ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
UNDESIRABLE EFFECTS
•Occasional cough, upper respiratory
infection
•Dizziness
•Diarrhea
•Overdosage: decreased blood pressure

ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
NURSING INTERVENTIONS
•Monitor renal function tests
•Monitor BP and apical HR prior to each
dose and on a regular basis
•If hypotension occurs, place client in the
supine position with feet slightly elevated
•Maintain hydration
ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
NURSING INTERVENTIONS
•Assist with ambulation when dizziness
occurs
•Assess for signs of upper respiratory
infection, cough, and diarrhea

ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
CLIENT EDUCATION
•Report any signs of an infection
•Caution about exercising during hot
weather due to potential dehydration and
hypotension

ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
BETA ADRENERGIC
BLOCKERS
SELECTIVE (BETA1
RECEPTORS):
Acebutolol (Sectral)
Atenolol (Tenormin)
Betaxolol (Kerlone)
Metoprolol (Lopressor)
“LOL TEAM”
 BETA ADRENERGIC
BLOCKERS
NONSELECTIVE (BETA1 and BETA 2
RECEPTORS):
Carteolol (Cartrol)
Carvedilol (Coreg)
Labetalol (Normodyne)
Nadolol (Corgard)
“LOL TEAM”
ACTION:
•Binds to Beta1 (cardiac) and/or Beta 2
(lungs) adrenergic receptor sites that
prevents the release of catecholamine

BETA ADRENERGIC BLOCKERS

 B1 BLOCKERS EFFECT 1

Beta1 Blockers affect the Beta1 receptors in the

heart. They decrease the excitability,
cardiac workload, oxygen
consumption, renin release and lower blood
pressure
 B2 BLOCKERS AFFECT 2

Beta2 Blockers stimulate the beta

receptors in the lung, relax bronchial
smooth muscle,improve vital
capacity, and
airway resistance. Higher doses
may cause undesirable cardiac effects
INDICATIONS:
•Hypertension, angina, MI, Migraine,
headaches, situational anxiety, thyrotoxic
storm/crisis, upper GI bleeding, familial
essential tremors, and assist in treatment
of dysrrhythmias

BETA ADRENERGIC BLOCKERS

Side EFFECTS:
Bradycardia,
hypotension,
dizziness,
dry mouth,
hyperglycemia,
fatigue,
nausea,
bronchospasms,
Nightmares and insomnia
NURSING INTERVENTIONS:
> Before administering these medications,
assess vital signs.
➢ Follow parameters before administering
dosage.
➢ Monitor side effects.
➢ Assess for orthostatic hypotension or signs of
decreased blood pressure.
NURSING INTERVENTIONS:
•Monitor blood sugar closely in clients
with diabetes
•Monitor triglyceride and cholesterol level
•Monitor BP and pulse prior to
administration
•If pulse is below 60 withhold the
medication and notify the physician
BETA ADRENERGIC BLOCKERS
CLIENT EDUCATION:
•Instruct client regarding self assessment
of pulse, character, and rhythm, signs
and symptoms of CHF
•Avoid heat, excessive exercise, hot
showers, baths, and hot tubs

BETA ADRENERGIC BLOCKERS

CALCIUM CHANNEL
BLOCKERS
Amlodipine (Norvasc)
Bepridil (Vascor)
Diltiazem (Cardizem)
Felodipine (Plendil)
Nicardipine (Cardene)
NIfedipine (Procardia)
Verapamil (Isoptin, Calan)
 CALCIUM CHANNEL BLOCKERS
ACTION:
These medications decrease cardiac contractility
by inhibiting calcium ions. CCBs are used to
promote dilation of the blood vessels, which
results in a decrease in blood pressure. They are
used for patients with hypertension,
dysrhythmias, and angina
CALCIUM CHANNEL BLOCKERS

INDICATION:
•Hypertension, angina, atrial fibrillation
or flutter, migraine headaches
Metabolized and
excreted by the liver.

PHARMACOKINETICS:
SIDE EFFECTS
Dizziness,
Constipation,
Hypotension,
Edema,
Headaches,
Bradycardia, and
Gingival hyperplasia.
CALCIUM CHANNEL BLOCKERS

NURSING INTERVENTIONS:
•Monitor hepatic and renal function
studies (Creatinine, AST/ALT)
•Monitor ECG and avoid giving when
heart blocks are present
•have emergency equipment available
with IV administration
CALCIUM CHANNEL BLOCKERS

NURSING INTERVENTIONS:
•Protect drug from light and moisture
CALCIUM CHANNEL BLOCKERS

NURSING INTERVENTION:
•Instruct to increase dietary fiber, fluid
intake, and exercise
•Avoid overexertion when anginal pain is
relieved
•Encourage to take with meals or milk
Diureticsclear excess fluid from the body
and regulate blood pressure by encouraging
the kidneys to excrete fluid.
3 MAJOR CLASS

1.Thiazides,
2. Potassium-sparing diuretics, and
3.Loop diuretics.
 THIAZIDE

 Definition:

 Thiazides decrease blood pressure and edema by excreting sodium and

water.
 Types:

 A. Hydrochlorothiazide (Hydrodiuril),
 B. chlorothiazide (Diuril),
 C. ametolazone (Zaroxolyn) are commonly used.
Patients with hypotension or renal failure.

CONTRAINDICATION
PHARMACOKINETICS

 Metabolized and excreted through the

kidneys.
 SIDE EFFECTS:
 Hypokalemia,
 hyponatremia,
 hypotension,
 dehydration,
 hyperglycemia,
 hyperuricemia, and
 orthostatic hypotension.
Obtain blood pressure and pulse before
administering.
Continue to monitor potassium levels. Monitor
output.
Administered by mouth (PO).

NURSING INTERVENTIONS
 LOOP DIURETICS

 Definition:

 These are the most effective of the diuretics. Loop diuretics reduce
sodium and water in the loop of Henle to decrease edema, fluid
overload, and hypertension. Typically given to patients who have
CHF, edema, or hypertension.
 TYPES

 Types of Loop Diuretics:

 Furosemide (Lasix),
 torsemide (Demadex),
 bumetanide (Bumex).
Contraindication:
 Patients who have hypokalemia, hypotension, or renal
failure.

 Pharmacokinetics: Metabolized and excreted by the

kidneys.
SideEffects: Dehydration, hearing loss,
hypokalemia, hyponatremia,
hypocalcemia and hypotension.
 NURSING INTERVENTION
 Obtain vital signs before administering.
 Monitor BP before and after.
 Monitor electrolytes.
 Obtain daily weights.
 Monitor urine output.
 Assess for output to see if the medication is effective.
 Canbe given IV or orally. Pay attention to the “–mide”
ending (which indicates a loop diuretic)
 POTASSIUM-SPARING DIURETICS

 Definition:

 Theseare diuretics in which potassium is spared and

excretion of sodium and water is increased to reduce
edema and fluid overload.
 Types:

 Spironolactone (Aldactone),
 eplerenone (Inspra), and
 triamterene (Dyrenium).

 Children

 Spironolactoneis the only potassium-sparing diuretic

recommended for children.
 PHARMACOKINETICS

Potassium-sparing diuretics are only available

orally and are absorbed in the GI tract. They’re
metabolized by the liver and excreted primarily in
urine.
 NURSING CARE:
 Monitor potassium levels and output.

 Instruct
Adults to avoid potassium-rich foods
(e.g. avocados, bananas, broccoli, tomatoes,
and dried fruits) and to have regular
monitoring of serum potassium levels.
CASE ANALYSIS 1
 CHOLESTEROL-LOWERING MEDICATIONS/
ANTIHYPERLIPIDEMIC MEDICATIONS

 used to treat hyperlipidemia—an increase in the level of

lipids in the blood. There is mounting evidence that the
incidence of coronary artery disease (CAD), the leading
killer of adults in the Western world, is higher among people
with high serum lipid levels
CORONARY ARTERY DISEASE

 characterized by the progressive growth of atheromatous

plaques, or atheromas, in the coronary arteries.
 Unmodifiable Risk Factors
 A. Genetic Predispositions
 B. Age
 C. Gender
 Modifiable Risk Factors
 A. Gout
 B. Cigarette smoking
 C. Sedentary Lifestyle
 D. Stress
 E. Hypertension
 F. Obesity
 G. Diabetes
 Other Factors

RISK FACTORS
 ANTIHYPERLIPIDEMIC MEDICATIONS
 I. HMG-CoA Reductase Inhibitors:
 Hydroxymethylglutaryl coenzyme A (HMG-CoA)
reductase

All “–statin” Endings

Definition: Known as “statins,” these medications lower cholesterol levels (LDL levels) by
targeting triglycerides. They are used to treat patients with high cholesterol and coronary
heart disease.
 Atorvastatin (Lipitor)
 lovastatin (Mevacor),
 rosuvastatin (Crestor),
 simvastatin (Zocor),
 pravastatin (Pravachol), and fluvastatin (Lescol).
 Other types of treatments
 are gemfibrozil (Lopid) and ezetimibe (Zetia) to treat high cholesterol

TYPES
 PHARMACOKINETICS

 The statins are all absorbed from the GI tract and

undergo first pass metabolism in the liver. They are
excreted through feces and urine. The peak effect of
these drugs is usually seen within 2 to 4 weeks. These
drugs are most effective when taken at night when the
liver is processing the most lipids.
CONTRAINDICATION

Hypersensitivity

Patients with Liver Disease

Pregnancy or Lactation
GI system:
 flatulence,
 abdominal
 pain,
 cramps,
 nausea,
 vomiting,
 constipation.

SIDE EFFECTS
 CNS effects:
 headache,
 dizziness,
 blurred vision,
 insomnia,
 fatigue,

SIDE EFFECTS
Gastro Intestinal:
> acute liver failure

Genito Urinary
> Acute Renal Failure

SIDE EFFECTS
NURSING INTERVENTION

 1. Administer the drug at bedtime

 2. Monitor serum cholesterol and LDL levels
 3. Arrange for periodic ophthalmic examinations
 4. Monitor liver function tests
 5. Exercise
NURSING INTERVENTION

 6. Encourage for lifestyle change

 7.
Withhold lovastatin, atorvastatin, or fluvastatin in any
acute, serious medical condition
 8. barrier contraceptives for women of childbearing age
 9.
Provide comfort measures to help the patient tolerate
drug effects.
NURSING INTERVENTION

10. Offer support and encouragement

11. Provide thorough patient teaching
CARDIAC GLYCOSIDES

 Definition:
These medications increase contractility and
cardiac output.
 Cardiac glycosides also decrease sodium and potassium
levels. They are used for patients with cardiac
tachycardia and heart failure.
ANTIANGINAL

 used to help restore the appropriate supply-and-demand

ratio in oxygen delivery to the myocardium.
CORONARY ARTERY DISEASE
 The
loss of oxygen and nutrients to myocardial tissue
because of diminished coronary blood flow.
 Fattyfibrous plaques, calcium-plaque deposits, or
combinations of both narrow the lumens of coronary
arteries, reducing the volume of blood that can flow
through them.
CAUSES

 Atherosclerosis, the most common cause of coronary artery disease, has been
linked to many risk factors. Some risk factors, such as the following, can't be
controlled.
 Age — Atherosclerosis usually occurs after age 40.
 Sex — Males are eight times more susceptible than are premenopausal females.
 Heredity — A positive family history of coronary artery disease increases the risk.
 Race — White males are more susceptible than nonwhite
ANTIANGINAL

 The 3 main classes of drugs used to treat angina pectoris

 nitrates and nitrites
 beta blockers
 calcium channel blockers (CCBs).
3 MAIN THERAPEUTIC OBJECTIVES OF
ANTIANGINAL DRUG THERAPY:

 (1)
minimize the frequency of attacks and decrease the
duration and intensity of the anginal pain;
 (2)
improve the patient’s functional capacity with as few
adverse effects as possible; and
 (3)
prevent or delay the worst possible outcome,
myocardial infarction.
NITRATES AND NITRITES

 Dilate all blood vessels.

 havea potent dilating effect on the large and small
coronary arteries.
TYPES

• Amyl nitrite (rapid acting)

• Nitroglycerin (both rapid and long acting)
• Isosorbide dinitrate (both rapid and long acting)
• Isosorbide mononitrate (primarily long acting)
INDICATIONS

 Used to treat stable, unstable, and vasospastic

(Prinzmetal) angina. Long-acting dosage forms are used
more for prevention of anginal episodes. Rapid-acting
dosage forms, most often sublingual nitroglycerin tablets,
or an intravenous drip in the hospital setting, are used to
treat acute anginal attacks.
CONTRAINDICATIONS

 drug allergy,
 severe anemia,
 closed-angle glaucoma,
 hypotension, and
 severe head injury.
SIDE EFFECTS

 headache, most common side effect which generally

diminishes soon after the start of therapy.
 tachycardia

 postural hypotension.
NURSING INTERVENTION

 Check Vital Signs

 Administer the drug while the patient is seated to avoid falls or
injury from drug-induced hypotension.
 monitor the patient’s chest pain
 Monitorthe patient’s response to drug therapy by measuring
the patient’s blood pressure and pulse rate and assessing for
the presence of headache, dizziness, and/or ightheadedness.